Long-term ganciclovir therapy for hepatitis B virus infection after liver transplantation

Background/Aims: Hepatitis B virus (HBV) disease on a liver graft is associ ated with florid viral replication and graft failure. The aim of this study performed between 1992 and 1995 was to investigate the safety and efficacy of long-term intravenous ganciclovir for HBV infection in liver transplant recipients. Methods: Twelve patients with HBV re-infection and four with de novo HBV in fection were studied, HBV DNA was positive in all (median titer: 437.5 pg/m l) and HBeAg was positive in seven. Intravenous ganciclovir was started aft er a median of 14.5 months from HBsAg positivation and continued for a medi an of 10 months. Results: A complete response with HBV DNA negativation was seen in ten case s, a partial response with a decrease of more than 50% of initial HBV DNA l evels in four and no response in two. Overall tolerance was good. Among the ten complete responders, two seroconverted for both HBsAg and HBeAg and on e for HBsAg alone, Among these ten patients, three were re-transplanted for liver failure: two of them are alive; three had a viral breakthrough durin g treatment; and four remained HBV DNA negative: two are alive and two died . Partial responders and nonresponders were treated with other antiviral ag ents and three were re-transplanted, two of them are alive. Overall 12 out of 16 patients (75%) survived with a median follow up of 46 months. Conclusions: Long-term intravenous ganciclovir can persistently inhibit HBV DNA replication in liver transplant recipients and is well tolerated. Furt her evaluation should be encouraged, especially for HBV recurrence after fi rst-line treatments.